Emergency Department (Ed) Overcrowding: Evidence-Based Answers to Frequently Asked Questions

Salway, RJ; Valenzuela, Rolando; Shoenberger, JM; Mallon, WK; Viccellio, Asa

doi:10.1016/j.rmclc.2017.04.008

Cited by 106 publications

(107 citation statements)

References 42 publications

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“…ED overcrowding is defined as the condition where the demand for emergency services outstrips the available resources of supplies, staff, and space (Bellow & Gillespie, 2014;Hwang & Concato, 2004;Fatovich, Nagree, & Sprivulis, 2005). Boarding is defined as a condition in which a patient needs to be transferred from the ED to an inpatient bed but no bed is available; thus, the patient remains in the ED, occupying an ED bed even though they no longer require ED-level care (Salway, Valenzuela, Shoenberger, Mallon, & Viccellio, 2017). ED overcrowding is generally associated with factors such as patient surge 1 and limited surge capacity.…”

Section: Ed Overcrowdingmentioning

confidence: 99%

Emergency department resilience to disaster‐level overcrowding: A component resilience framework for analysis and predictive modeling

Davis

Zobel

Khansa

et al. 2019

J of Ops Management

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Overcrowding poses a serious challenge to the operations of health care facilities, especially those with a mandate to provide emergency care. A better understanding of emergency department (ED) performance during disaster‐level overcrowding is a key to increasing a facility's resilience, optimizing patient outcomes, and more effectively allocating resources. With this in mind, this study quantitatively examines the extent to which different factors contribute to the resilience of hospital EDs during disaster‐level overcrowding events. A modeling framework was developed in collaboration with the Carilion Clinic ED, a level one trauma center in Virginia. The testing and analysis of the approach is based on data from actual disaster‐level overcrowding events that occurred in the Spring of 2016. Results indicate that by considering not only the capacity for resisting such events but also the capacity for recovering from them more quickly, hospital decision makers can improve both their operational effectiveness and the patient experience. Furthermore, by using our framework to identify precipitating factors and predict severe overcrowding, hospital decision makers can implement changes to improve the future resilience of their ED to such overcrowding events.

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Section: Ed Overcrowdingmentioning

confidence: 99%

Emergency department resilience to disaster‐level overcrowding: A component resilience framework for analysis and predictive modeling

Davis

Zobel

Khansa

et al. 2019

J of Ops Management

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“…Hospitals have experienced a disproportionate increase in ED presentations over the past decades1 2 leading to overcrowding, treatment delays, and adverse patient outcomes 3. Evidence suggests that ED performance and patient flow can be improved through rapid assessment and early decision making by senior ED clinicians 4–6.…”

Section: Introductionmentioning

confidence: 99%

Extending the Sydney Triage to Admission Risk Tool (START+) to predict discharges and short stay admissions

2018

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“…ED overcrowding is rather an old problem that has, in recent decades, been in focus because of its growing impact on hospital's planned activities and patients' safety . This report has no intention to discuss the reasons for either overcrowding or the high rate of morbidity and mortality due to overcrowding and longer LOS at EDs.…”

Section: Discussionmentioning

confidence: 99%

Reasons for longer LOS at the emergency departments: Practical, patient‐centred, medical, or cultural?

Khorram‐Manesh

Wennman

Andersson

et al. 2019

Health Planning & Management

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Summary Emergency department (ED) overcrowding is caused by external and/or internal factors. One critical internal factor, leading to longer length of stay (LOS) at ED (eg, frequent ED users), is the physician's uncertainty in management of patients with unclear diagnosis and or complex medical history. The aim of this study was to identify whether the causes of physicians' uncertainty was practical, patient‐centred, medical, or cultural. Using earlier published dimensions of uncertainty, 18 physicians were asked to reply to a template by choosing a relevant dimension that causes a delay in assessment of a known complex patient. This stage was completed by interviews through which participants had an opportunity to express their concerns and critical thoughts, if any. The data obtained from the template were collected and analysed. The interviews were recorded and transcribed verbatim. The results of the template indicated medical dimension as the main factor in delayed assessment of a complex patient. However, this finding was challenged by the results of the interviews, which indicated higher impact of personal/routines/cultural dimension (eg, being afraid of criticism, reprimand, and gossip or feelings of guilt). Although medical, patient‐centred, and practical issues are important causes of longer LOS at ED, physicians' working and professional environment may have a higher impact than previously perceived. The uncertainty caused by interpersonal, organisational, and cultural issues within a clinic/hospital seems to influence the physician's ability to make decisions and thus a patient's medical outcome.

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Emergency Department (Ed) Overcrowding: Evidence-Based Answers to Frequently Asked Questions

Cited by 106 publications

References 42 publications

Emergency department resilience to disaster‐level overcrowding: A component resilience framework for analysis and predictive modeling

Emergency department resilience to disaster‐level overcrowding: A component resilience framework for analysis and predictive modeling

Extending the Sydney Triage to Admission Risk Tool (START+) to predict discharges and short stay admissions

Reasons for longer LOS at the emergency departments: Practical, patient‐centred, medical, or cultural?

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